<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html>
<head>
    <meta http-equiv="Content-Type" content="text/html; charset=UTF-8"/>
    <title>Web Form</title>
</head>

<body>
    <div class="container c26 tpm">

        <h2 class="bottom">Student Profile</h2>
        <hr />
        <form id="frmStudent" method="post">

			<div class="c26">
				<div class="container pad">
					<div class="column c12">
						<label class="left">First Name:<br /><input class="textbox" id="txtFName" name="txtFName" type="text" size="30"  /></label><br />
						<label class="left">Last Name:<br /><input class="textbox" id="txtLName" name="txtLName" type="text" size="30"  /></label><br />
						<label class="left">Street:<br /><input class="textbox" id="txtStreet" name="txtStreet" type="text" size="30"  /></label><br />
						<label class="left">City:<br /><input class="textbox" id="txtCity" name="txtCity" type="text" size="30"  /></label><br />
					</div>
					<div class="column c12">
						<label>State:<br />
						<select name="lstCountry" class="c11">
							<option value="br">Brazil</option>
							<option value="ca">Canada</option>
							<option value="fr">France</option>
							<option value="ja">Jamaica</option>
							<option value="usa">United States</option>
							<option value="uk">United Kingdom</option>
						</select></label><br />
						<label>State:<br /><input class="textbox" id="txtState" name="txtState" type="text" size="30"  /></label><br />
						<label>Zip:<br /><input class="textbox" id="txtZip" name="txtZip" type="text" size="30"  /></label>

                        <div class="tpb tpm">
                            <strong>Contact Via: </strong><br />
                            <label><input name="chkFeatures" type="checkbox" value="phone" /> Phone</label>&nbsp;
                            <label><input name="chkFeatures1" type="checkbox" value="email" /> Email</label>&nbsp;
                            <label><input name="chkFeatures2" type="checkbox" value="fax" /> Fax</label>&nbsp;
                        </div>
					</div>
				</div>

				<div class="hlf-pad lightgray" align="right">
					<div class="left">The form will retain its values after being submitted.</div>
					<input id="btnSave" type="submit" value="Submit" />
				</div>
			</div>

        </form>

    </div>

</body>

</html>
